Understanding the difference between Type 1 and Type 2 diabetes.

Type 1 Diabetes (T1DM) is an ‘auto-immune’ condition.  The body attacks the insulin making cells and the result is that the body produces no (or very little) insulin.  This form of diabetes is managed through insulin injections (healthy eating and activity are also important). This article covers link the between T1DM and coeliac disease.

Type 2 Diabetes (T2DM) is the more common form of diabetes.  This occurs when the body either does not produce enough insulin, OR the cells in the body do not recognise the insulin which in turn leads to high levels of glucose (sugar) in the blood.  This excess glucose can damage internal systems over a period.  Many people with T2DM (not all), can manage the condition by having a healthy balanced diet and keeping active.

How common is it to have Type 1 diabetes and coeliac disease?

For people with T1DM, there is a 10%  increase risk of also being diagnosed with coeliac disease.  Both are autoimmune diseases that affect the immune system.

Symptoms of coeliac disease

Some common symptoms in adults can include diarrhoea, constipation, weight loss, nausea, flatulence, abdominal pain or discomfort, mood disorders and depression, mouth ulcers, joint pain, fatigue, and osteopenia/osteoporosis.

What if I have no symptoms of coeliac disease?

Some people with T1DM have mild or no obvious symptoms of coeliac disease.  If you have coeliac disease evidence shows that any exposure to gluten, irrespective of whether it causes symptoms or not, causes damage to the small intestine.  The only treatment for coeliac disease is a strict gluten-free diet.

Diagnosis of coeliac disease

It is important to consume a gluten-containing diet while undergoing diagnostic testing for coeliac disease.  A blood test (coeliac serology) will check for antibodies that can indicate coeliac disease.  In adults, diagnosis should be confirmed with a biopsy.  For children, this may not be required.  See your specialist for more information.

Monitoring your blood glucose levels  if diagnosed with coeliac disease

Once you start on a gluten-free diet, your blood sugar levels may change.  This can happen due to the change in diet and the increased absorption of nutrients as the gut heals over time.  It is important to continue to monitor your blood sugar levels during this stage and match your insulin requirements as appropriate, working closely with your specialist diabetes team.

Managing your diet with both conditions:

Naturally, gluten-free foods include fruit, vegetables, meat, eggs, dairy, legumes, and nuts, continue to consume these fresh or frozen – if processed however, check no gluten has been added in the manufacturing.  The gluten-free diet requires the complete elimination of the following grains: wheat, rye, barley, oats, and ingredients derived from them. Common sources of gluten include bread, cereals, pasta, pastry, pizza, biscuits, crackers, cakes, and breadcrumbs.  There are gluten-free substitutions available for many of these products.

Top Food Tips:

1. Eat regular meals daily
2. Include gluten-free starchy carbohydrate foods at each meal
3. Reduce fat – particularly saturated fats from your diet
4. Include fruit and vegetables – aim for five vegetables and two fruits daily
5. Include more pulses/legumes in your diet
6. Add oily fish twice a week to your diet
7. Limit sugary foods and drinks
8. Reduce salt in your diet

It is important to be able to read and understand the labels on your foods.  We have resources available to help you be confident when label reading – see our website www.coeliac.org.nz or contact us at healthpromotion@coeliac.org.nz

Exercise Tips:

Physical activity can help improve mood and boost energy levels. There are some considerations to be aware of when you exercise with T1DM and coeliac disease.

• When initiating a new exercise routine, talk with your doctor or diabetes team to help advise on appropriate blood sugar levels and additional food/insulin requirements.
• Stay safe whilst exercising by listening to your body and recognising how you feel – shaky, sick, confused – STOP and test your blood sugar levels – follow the guidance of your health professional.
• Always carry a hypo kit – fast-acting carbohydrates – glucose tablets, fruit juice, etc.
• Monitor your blood sugar levels in the hours following your exercise and be aware of any drop. Act accordingly.
• Stay hydrated with appropriate fluids before, during, and after exercise. For competitive athletes, ensure you consult with a dietitian working in this area for individualised support and guidance.

*Type 2 Diabetes is not related to coeliac disease.

For more information including the diet guide, label reading tips and other resources visit www.coeliac.org.nz.

Check out our video About Type 1 Diabetes and Coeliac Disease on YouTube.

For Diabetes information visit:  www.diabetes.org.nz